Can Competing Health Plans Collaborate to Improve Primary Care?

In America’s highly fragmented system of health provider reimbursement, primary care practices are more likely to improve quality and control costs if payers set a common set of standards and expectations. As a result, federal and state policymakers have undertaken a number of initiatives to coordinate the work of health care payers, including government programs and multiple commercial insurers.

The Centers for Medicare and Medicaid Services’ Comprehensive Primary Care initiative, now in its seventh year, is the most ambitious of its nationwide multi-payer efforts. For a new Milbank Memorial Fund issue brief, the Los Angeles Times’ Noam Levey interviewed participating payers in three distinct regional markets in the Comprehensive Primary Care Plus program: Colorado, Oklahoma, and Greater Philadelphia. While the challenges inherent in fostering collaboration across companies that usually compete vigorously were handled differently in each market, common themes emerged including strong payer commitment and the need for sustained federal leadership.

“The experiences of payers in three diverse markets participating in the federal CPC initiatives bear testament to the difficulty of this work,” Levey says. “Although many payers are interested in ways to accelerate these changes, the CPC participants in these three markets still maintain a substantial interest in and commitment to sticking with the ongoing alignment efforts.”